MEDICARE: OLIVIA CHEYENNE BURRIS LCDCII

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	LCDCII.162203	OH

General Provider Information

NPI Number	:	1821879875
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	OLIVIA CHEYENNE BURRIS LCDCII

Provider Business Mailing Address
First Line	:	355 E CAMPUS VIEW BLVD STE 285
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-5680
Country	:	US
Telephone Number	:	407-874-0499
Fax Number	:

Provider Business Practice Location Address
First Line	:	355 E CAMPUS VIEW BLVD STE 285
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43235-5680
Country	:	US
Telephone Number	:	614-750-9899
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/06/2023
Last Update Date	:	04/08/2026

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